Efforts to build accountability for health systems at the local and national levels, and integrated initiatives between the public sector and civil society, promotes country ownership and allows communities to advocate for health and public policies that benefit them the most. Building accountability into the health system can take many forms, but often entails improving communication between the community and the government and creating greater transparency in decision making at all levels.

Memunatu Alhassan lives with her husband, the village chief, in the Toroyili community in Northern Ghana’s Tolon District. In her remote village, the absence of latrines and a sanitation system made open defecation the norm. As a result of USAID’s Community Led Total Sanitation program and a community training for better nutrition practices and policies, she realized how critical clean water and good hygiene were for better nutrition outcomes. Soon after, she built a latrine and two tippy-tap handwashing stations in her household and removed the animal feces in and around her home to create a clean play space for her grandchildren. She taught her neighbors what she learned after attracting much attention and support from her community. Memunatu’s community is located in 1 of 25 districts in northern Ghana, where USAID works with existing regional, district, and community governance structures and groups— including farmers’ groups, youth groups, natural leaders, water and sanitation committees, and women’s groups— to identify health and nutrition related problems and develop plans to address them. USAID has partnered with districts and communities to implement the Community Led Total Sanitation process in 1,041 communities. As a result of USAID’s support, coupled with the village’s collective action to build latrines, Memunatu’s community became one of 360 communities that achieved Open-Defecation Free (ODF) status—a critical step to improving nutritional status in the first 1,000 days between pregnancy and a child’s second birthday. Responsibility for governing multi-sectoral nutrition activities falls across various government and ministry lines and requires commitment and capacity at all levels.

USAID supports health governance and collaboration across sectors to promote accountability and transparency for health and development activities and achieve greater impact at the community level in Northern Ghana. Health governance interventions help improve the responsiveness of health systems to their populations, thus addressing perceptions of poor quality or mistreatment which may impede populations from accessing health services. Ghana’s focus on health governance interventions, when scaled up with a package of other proven health systems interventions, can contribute to saving over 84,000 lives from 2016-2020.

Meet more of the women and children that benefit from USAID's efforts.

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